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Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry.
J Cardiothorac Vasc Anesth. 2010 Jun; 24(3):422-6.JC

Abstract

OBJECTIVES

Dilutional coagulopathy as a consequence of cardiopulmonary bypass (CPB) system priming may also be affected by the composition of the priming solution. The direct effects of distinct priming solutions on fibrinogen, one of the foremost limiting factors during dilutional coagulopathy, have been minimally evaluated. Therefore, the authors investigated whether hemodilution with different priming solutions distinctly affects the fibrinogen-mediated step in whole blood clot formation.

DESIGN

Prospective observational laboratory study.

SETTING

University hospital laboratory.

PARTICIPANTS

Eight male healthy volunteers.

INTERVENTIONS

Blood samples diluted with gelatin-, albumin-, or hydroxyethyl starch (HES)-based priming solutions were ex-vivo evaluated for clot formation by rotational thromboelastometry.

MEASUREMENTS AND MAIN RESULTS

The intrinsic pathway (INTEM) coagulation time increased from 186 +/- 19 seconds to 205 +/- 16, 220 +/- 17, and 223 +/- 18 seconds after dilution with gelatin-, albumin-, or HES-containing prime solutions (all p < 0.05 v baseline). The extrinsic pathway (EXTEM) coagulation time was only minimally affected by hemodilution. Moreover, all 3 priming solutions significantly reduced the INTEM and EXTEM maximum clot firmness. The HES-containing priming solution induced the largest decrease in the maximum clot firmness attributed to fibrinogen, from 13 +/- 1 mm (baseline) to 6 +/- 1 mm (p < 0.01 v baseline).

CONCLUSIONS

All studied priming solutions prolonged coagulation time and decreased clot formation, but the fibrinogen-limiting effect was the most profound for the HES-containing priming solution. These results suggest that the composition of priming solutions may distinctly affect blood clot formation, in particular with respect to the fibrinogen component in hemostasis.

Authors+Show Affiliations

Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20056447

Citation

Brinkman, Arinda C M., et al. "Profound Effects of Cardiopulmonary Bypass Priming Solutions On the Fibrin Part of Clot Formation: an Ex Vivo Evaluation Using Rotation Thromboelastometry." Journal of Cardiothoracic and Vascular Anesthesia, vol. 24, no. 3, 2010, pp. 422-6.
Brinkman AC, Romijn JW, van Barneveld LJ, et al. Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry. J Cardiothorac Vasc Anesth. 2010;24(3):422-6.
Brinkman, A. C., Romijn, J. W., van Barneveld, L. J., Greuters, S., Veerhoek, D., Vonk, A. B., & Boer, C. (2010). Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry. Journal of Cardiothoracic and Vascular Anesthesia, 24(3), 422-6. https://doi.org/10.1053/j.jvca.2009.10.018
Brinkman AC, et al. Profound Effects of Cardiopulmonary Bypass Priming Solutions On the Fibrin Part of Clot Formation: an Ex Vivo Evaluation Using Rotation Thromboelastometry. J Cardiothorac Vasc Anesth. 2010;24(3):422-6. PubMed PMID: 20056447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Profound effects of cardiopulmonary bypass priming solutions on the fibrin part of clot formation: an ex vivo evaluation using rotation thromboelastometry. AU - Brinkman,Arinda C M, AU - Romijn,Johannes W A, AU - van Barneveld,Lerau J M, AU - Greuters,Sjoerd, AU - Veerhoek,Dennis, AU - Vonk,Alexander B A, AU - Boer,Christa, Y1 - 2010/01/06/ PY - 2009/07/12/received PY - 2010/1/9/entrez PY - 2010/1/9/pubmed PY - 2010/8/24/medline SP - 422 EP - 6 JF - Journal of cardiothoracic and vascular anesthesia JO - J Cardiothorac Vasc Anesth VL - 24 IS - 3 N2 - OBJECTIVES: Dilutional coagulopathy as a consequence of cardiopulmonary bypass (CPB) system priming may also be affected by the composition of the priming solution. The direct effects of distinct priming solutions on fibrinogen, one of the foremost limiting factors during dilutional coagulopathy, have been minimally evaluated. Therefore, the authors investigated whether hemodilution with different priming solutions distinctly affects the fibrinogen-mediated step in whole blood clot formation. DESIGN: Prospective observational laboratory study. SETTING: University hospital laboratory. PARTICIPANTS: Eight male healthy volunteers. INTERVENTIONS: Blood samples diluted with gelatin-, albumin-, or hydroxyethyl starch (HES)-based priming solutions were ex-vivo evaluated for clot formation by rotational thromboelastometry. MEASUREMENTS AND MAIN RESULTS: The intrinsic pathway (INTEM) coagulation time increased from 186 +/- 19 seconds to 205 +/- 16, 220 +/- 17, and 223 +/- 18 seconds after dilution with gelatin-, albumin-, or HES-containing prime solutions (all p < 0.05 v baseline). The extrinsic pathway (EXTEM) coagulation time was only minimally affected by hemodilution. Moreover, all 3 priming solutions significantly reduced the INTEM and EXTEM maximum clot firmness. The HES-containing priming solution induced the largest decrease in the maximum clot firmness attributed to fibrinogen, from 13 +/- 1 mm (baseline) to 6 +/- 1 mm (p < 0.01 v baseline). CONCLUSIONS: All studied priming solutions prolonged coagulation time and decreased clot formation, but the fibrinogen-limiting effect was the most profound for the HES-containing priming solution. These results suggest that the composition of priming solutions may distinctly affect blood clot formation, in particular with respect to the fibrinogen component in hemostasis. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/20056447/Profound_effects_of_cardiopulmonary_bypass_priming_solutions_on_the_fibrin_part_of_clot_formation:_an_ex_vivo_evaluation_using_rotation_thromboelastometry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(09)00400-5 DB - PRIME DP - Unbound Medicine ER -